Women Refusing Standard Obstetric Care: Maternal Fetal Conflict or Doctorpatient Conflict?
Journal of Pregnancy and Child Health
Objectives: Some women choose to give birth outside medical protocol or ignore medical advice. This could be perceived as a maternal-fetal conflict. Many professionals are unsure about the legal possibilities and ethical intricacies in these circumstances, and the position of the fetus. This paper attempts to elucidate and provide a framework for these issues. Methods: We did a literature search on Pubmed in October 2014, using the terms "legal/law", "pregnant/ pregnancy", "legal measures",
... rt-ordered caesarean/cesarean", "birth", "childbirth" and "homebirth". We also reviewed some professional organisations' guidelines. Results: Much has been written about legal restrictions and measures against women who go against medical advice, for instance court-ordered cesarean sections or forced hospital admissions. Medical professionals fear litigation in case of a bad outcome when the mother's wishes are respected. However, medical assessment of risk and benefit is sometimes inaccurate. Maternal competence is a central issue. The pregnant patient has the right to autonomy, bodily integrity, freedom and self-determination and the fetus has the right to have its life protected. However, it is unethical to invade one person's physical integrity for the benefit of another, especially if the other is not born yet. Religious rights are generally respected, but this is not unlimited. International guidelines on this subject generally state that a competent pregnant patient has the same rights as any other person and that her autonomy should prevail. Conclusions: In contrast to the general perception the conflict described is not between mother and child but between doctor and patient. Communication can be the key to solving this problem. In cases of continued disagreement, the mother's autonomy should prevail. Significance: In this era of social media and access to information for all, patients are better informed than ever before. At the same time, shared decision making is rapidly becoming the norm. Obstetrical care providers are increasingly faced with pregnant patients who refuse some or all proposed interventions. These decisions may appear to be at odds with what medical professionals deem best for the fetus. We have attempted to provide a legal and ethical framework for looking at this dilemma. Many professional organizations have created guidelines on how to handle situations of perceived maternal-fetal conflict. The American Congress of Obstetricians and Gynaecologists states: "Pregnant women's autonomous decisions should be respected. Concerns about the impact of maternal decisions on fetal well-being should be discussed in the context of medical evidence and understood within the context of each woman's broad social network, cultural beliefs, and Citation: Hollander M, Dillen JV, Janssen TL, Leeuwen EV, Duijst W, et al. (2016) Women Refusing Standard Obstetric Care: Maternal Fetal Conflict or Doctor-patient Conflict?.